You had the foresight to purchase long term disability insurance benefits to replace your lost income if you become unable to work due to an injury or disability. You’ve consistently paid your disability insurance premiums month after month, year after year, or even decade after decade. You suffer a debilitating injury or develop a disabling medical condition that keeps you from being able to work consistently. You may have even been approved for Social Security Disability Insurance benefits. Despite all of the above, you receive a disability denial letter.
The last thing you ever imagined or want to hear is that the insurance company you’ve been paying has decided not to approve your disability claim. That means the carrier has refused to pay you the long term disability benefits that you are entitled to under your LTD policy.
Unum Disability Denials Are Not Uncommon
Unum, also known as Unum Group, has acquired and taken over all long term disability policies issued by Provident Life and Accident, UnumProvident, First Unum Life, Colonial Life & Accident Insurance, and The Paul Revere Life Insurance Company. Unum is one of the largest disability insurance carriers in the industry, offers both group disability and individual disability insurance policies, and has a long history of denying claims in bad faith.
Unfortunately, this happens all too often. Unum denies legitimate disability claims, leaving the claimants without the very benefits they thought would be there in their time of need. Long term disability claimants are left scrambling to figure out how to pay for their food, shelter, and other monthly bills, and leave them wondering how they will support their families.
If this has happened to you, then you are not alone. Unum has a history of denying legitimate disability claims. The following is a clip from the news investigation program 60 Minutes, which did a piece on Unum’s disability claims process:
Many individuals with Unum long term disability insurance policies need to hire an experienced disability lawyer to help them fight for their benefits.
With over a decade of experience in representing the disabled in insurance claims across the United States, experienced disability insurance lawyer Nick Ortiz has the skill and insight needed to help you address a wide range of issues relating to disability law and your claim for disability benefits.
The Ortiz Law Firm typically gets involved in a claim once it has been denied or terminated, so this article and the video below will focus on what to do when you receive a claim denial. If you still need to apply for benefits, we’ve also included information relating to the application process to help you get started.
Filing a Disability Insurance Claim with Unum
You should notify Unum right away if you are unable to work due to sickness or injury. According to Unum’s website, you can file long term disability claims online or with paper forms that Unum has made available online, but you’ll need to contact your HR department at work to find out if you can file over the phone. Once filed you can also check your claim status and manage your claim online.
When you are attempting to obtain long term disability benefits under a policy offered by Unum, you should:
- Hire an experienced Unum disability insurance claims lawyer. While it is possible to file a claim for Unum benefits without legal representation, our assistance in the process may make the difference between an approval and a denial. One of our firm’s guiding philosophies is that knowledge is power, and this is especially true when dealing with Unum insurance company. Filing a successful claim for disability benefits can be stressful, difficult, and downright overwhelming. Our familiarity and knowledge of Unum’s claims handling procedures can be invaluable during your pursuit of benefits. Mr. Ortiz has experience in reviewing Unum’s claim requirements, the reasons they deny claims, and the mistakes to avoid while filing a disability claim.
- Do not be intimidated! Unum has earned a reputation for having a burdensome claims procedure, intimidating their policy-holders, and offering “low ball” lump-sum settlements just to make claimants go away. When your financial survival is on the line, you must not let yourself be intimidated by Unum and its claims representatives. Mr. Ortiz is a disability insurance lawyer who has stood up to disability insurance companies time and time again, and has successfully recovered benefits for dozens of clients who were entitled to long term disability benefits.
- Explore every available avenue in the claims process. If you have been denied, you have the right to file a certain number of appeals directly with Unum. Should you exhaust your appeals and administrative remedies, you have the right to file a lawsuit under the ERISA act, which will be reviewed by a federal judge. Our staff will help you understand all of your options under ERISA and will guide you through every option available to you.
- Determine whether your claim is even covered by ERISA. In limited circumstances – such as where you are a government employee or purchased an individual disability insurance policy – you may have the right to go directly to state court (and not a federal court) without filing any appeals. Experienced disability insurance lawyers will help you determine whether your claim is subject to state law or ERISA. In Florida, state laws protect policyholders much more than ERISA regulations.
UNUM Contact Information
If you have an active disability claim with Unum, you can contact them using the contact information below:
Unum Life Insurance Company of America
The Benefits Center
PO Box 100158
Columbia, SC 29202-3158
Did You Receive a Denial Letter? An Unum Disability Attorney is Ready to Fight for You
Reasons Your Claim May Have Been Denied
There are many reasons why Unum typically denies a claim.
- Unum had your claim reviewed by one of their physicians in what they call a peer-review evaluation. That means they sent your medical records to one of their doctors. And their doctor has given an opinion as to what you can and can’t do. And based upon that doctor’s opinions, the insurance company says they think you could go back to work;
- Unum ordered a vocational analysis of your claim. What that means is that they’ve sent your file to one of their job experts and their job expert says that based upon a review of your file that you can return to work in some capacity;
- Unum says there is just insufficient medical evidence. They may say that ”we don’t think that the evidence in your medical records shows that you’re unable to perform your job or maybe any other job in the economy.”
- There’s a change in the definition of disability. Most long term disability policies have two definitions of disability, one for the “own occupation” period and one for the “any occupation” period. This typically occurs after 24 months where they may have approved your case while saying you cannot do the material duties of your job, which is your individual occupation. But they may say that you can do other types of work, meaning that you could do any occupation. So if Unum terminated your claim after two years, then you may have the right to appeal that as well.
If you filed your claim on your own and received notice that UNUM has denied your claim, it is strongly recommended that you do not proceed through the appeal process without an attorney.
How the Ortiz Law Firm Will Help You Obtain Benefits
Our goal is to document your disability in a manner that clearly demonstrates your impairments and your qualification for benefits. We will work with you to gather the appropriate evidence and documentation to satisfy the requirements of your disability plan and will work diligently to address any purported deficiencies Unum found with your documentation and paperwork as we prepare to appeal the claim denial.
We will also prepare questionnaires for your medical providers that are customized to your disabling conditions (also known as an Attending Physician’s Statement or a Medical Source Statement). Unum may provide you with a generic Attending Physician’s Statement form, but this form is designed to apply to every claim whether the claimant is suffering from a heart condition or a broken ankle. The limitations and restrictions for someone with a heart condition are entirely different from the limitations and restrictions for someone with a broken ankle, so using a form that only asks about the limitations and restrictions that apply to you will make it much easier for your doctor to complete the form.
Can I File a Lawsuit Against Unum?
In some cases, we are successful in having Unum put the claimant “on claim”, which means that the claim was approved and benefits were paid during the internal appeals process with Unum’s claims department without resorting to a lawsuit. In other instances, however, Unum may continue to deny your claim.
If you’ve exhausted your appeals, we’re here to help you file a lawsuit against the insurance company. If Unum is just flat out taking way too long to issue a decision in your case, the Ortiz Law Firm can advise you as to what your legal options are to enforce your rights. Should the internal appeals process fail, you have the right to file an ERISA lawsuit to have your case reviewed by a federal judge. We will help you file the ERISA suit, and prepare all necessary documentation for the court review process.
Work With an Experienced Long Term Disability Attorney
At the Ortiz Law Firm, we understand how frustrating it can be to receive a disability claim denial. Mr. Ortiz is an experienced disability attorney who has worked with numerous clients who have received denial letters from Unum claims representatives. Some claimants are denied from the initial application, while others receive benefit cessation letters – which means their benefits are being “cut-off” or terminated. The experience we have gained while helping past clients fight insurance companies like Unum has given us great insight into the best steps to take to improve your chances of recovering benefits against Unum.
Contact our office online or call (888) 321-8131 to schedule a free consultation with an experienced disability attorney to discuss your claim and learn how we can help you fight for the benefits you deserve.